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Why tube weaning is cheaper than 6 months of continuous tube feeding.

From a financial point of view a feeding tube produces enormous costs for either parents if they have to pay out of pocket or for their health insurance. Besides the direct costs of tube insertion (in case of Percutaneous endoscopic gastrostomy (PEG) or jejunostomic endoscopic gastrostromy (JEG) tubes including surgery), indirect costs occur as well: Costs for consultations of medical professionals (tube feeding team), for medical supplies (tube formula, tubes, pumps, changes of the tube, etc.), and for the parents (non productive time due to increased care requirements, etc.). Having spoken to parents and from the data we have gathered from the literature, we’ve come up with an approximation of the costs that a child with a feeding tube incurs based on these different sources of costs. It is important to note though that these costs can vary widely from country to country and depending on the specific brand used.

1. Nutrition

Let’s start with the most obvious cost. In Europe, most patients receive the tube formula Nutrini Energy (dependent on age and requirements of the patients). Based on current information (2012) the formula costs about EUR 20.– per day for one patient. These costs are frequently automatically covered by the health insurances, so parents don’t learn about the actual cost of it. In sum the yearly costs amount to 7,300.– per patient [2]. If the child has a metabolic disorder or other diagnosis connected to which food it can consume, other more specialized formula will be prescribed, often at a much higher cost.

2. Feeding pump

With their formula and the tubes, many parents receive a feeding pump to take home when they leave the hospital. This device (see here for an example) is supposed to make the feeding process less cumbersome and possibly even help the child cope better with the nutrition as it releases only the set amount of formula in a given time period. Depending on the model it costs between EUR 1,000 and 2,000.– [3] and requires annual maintenance work, which can increase the amount by roughly one third.

3. Maintenance costs for the different feeding tubes

Maintenance costs for feeding via a G- (PEG) or J-tube (JEG)

If a PEG or JEG is used, according to medical regulations, the button has to be changed every two to three months. One costs about EUR 250.– (2012). Therefore, the annual costs amount to approx. EUR 1,000.– per patient [4]. Surgical PEG or JEG insertion costs about EUR 3,000.– (again, this cost is highly dependent on the country, figure given is for Austria). This leads to total costs of EUR 4,000.– per patient per year.

Maintenance costs for feeding via a NG-tube

According to general prescriptions, on average a NG-tube has to be changed every 14 days. As one NG-tube costs about EUR 10.– the total amount is EUR 240.– per patient per year. There is no scientific evidence that long-term enteral feeding is actually better for the child with a G-tube, but many practitioners will advise the family to transition to a G-tube when the child has been on the NG-tube for longer than 3 months. The transition to the G-tube feeding produces the costs mentioned on the left.

4. Costs for accidental tube removal

As you might know, we deal mostly with children between the age of 0-6 and the majority of our patients are under 3 years old. This means that they tend to be very active, especially during their sleep and a lot of them will pull their tubes during their sleep. The tube might be itching them or be in the way or just be plain uncomfortable. For every tube pulled, a new one has to be inserted. If the parents can’t do it themselves or are afraid to do it (including verifying the correct placement of the tube), these costs will arise:

  •  Cost of the medical professional to reinsert the tube.
  •  Cost of the new feeding tube itself (see above).
  •  Costs to verify the correct placement of the NG-tube

Per additional NG-tube placement, this costs approx. EUR 500.– and with many children pulling out their tubes every couple of weeks or even every couple of days, the added cost can be substantial.

Additionally, many children who are previously on an NG-tube will receive a G-tube if they pull out their tubes too often so that it’s easier to handle for the parents. This again produces surgical costs of around EUR 3,000.– (in Austria)[5].

5. Costs for tube related hospital stays

A fact that is not quite obvious in the beginning is that children with feeding tubes tend to get readmitted to the hospital more often than those who don’t have a feeding tube. This is not just because many of them face other underlying illnesses, the reason for these readmissions is that they had issues with their feeding tube. According to our NoTube team member Prof. Marguerite Dunitz-Scheer, MD, who has supervised over 3’000 patients with feeding tubes, about 30% of all patients with feeding tubes suffer from tube-related complications, which require them to stay in the hospital for some time. As you can imagine, the cost for such inpatient stays can be anywhere from several hundred Euros per night on a “normal” children’s ward to several thousand Euros per night on the intensive care units.

6. Costs for the parents

Heyman and his colleagues (2004) was able to prove that tube fed children need 100% more active parental care time than children without feeding tubes. Whereas mothers with children who don’t have a feeding tube spend about 200 minutes caring for their child every day, mothers with children on feeding tubes spend 484 minutes (or 8 hours!) per day caring for them. He then calculates that the value of the maternal care that children without feeding tubes receive is approx. USD 15,000.– per year. This means that if these mums hadn’t had a child and would instead spend this same time working, that’s the mean annual wage that they could expect to earn. This number is bound to change as wages go up and women receive better wages. Now by contrast since the mother of a tube-fed child will spend so much more time with her child, her working time would be worth USD 37,232.–. The difference of USD 22,228.– then goes to the expenses of the family and the economy as a whole [6]. In many families that we see, grandparents are more involved than they otherwise would be, friends are helping out and fathers tend to work less than full-time. Calculating these hours as well would hence likely result in an even bigger number.

7. Having a child with a feeding tube:

All costs combined

Now that we’ve looked at all these costs separately, we added them up. Take this table with a grain of salt and read again above why some of these numbers vary widely in practice. Since some children never have to be readmitted to the hospital and some frequently and there is no data on average hospital readmission of tube-fed children, this cost was not included in the table below. The same goes for accidental tube removals.

costs.english
As you can see, even without the added loss of maternal income, the cost of tube feeding is so high that from a purely financial point of view, tube weaning costs less than half of the annual costs of continuing to tube feed (Netcoaching costs EUR 3,400.- whereas continued tube feeding costs EUR 9,060.– and 9,800.– respectively).
If you want to learn more about tube weaning and how to afford it, download our free guide here!
[1]Literature about this subject can be found online: http://notube.com/info/literature
[2]http://www.apo-rot.at/index_details.html?_filterartnr=2132817&_nav=suche&_random=-1817029291, link from 19.12.2012
[3]http://www.idealo.de/preisvergleich/OffersOfProduct/1477969_-flocare-infinity-enterale-ernaehrungspumpe-pfrimmer-nutricia.html, link from 19.12.2012
[4]http://www.hauptverband.at/mediaDB/823937_PEG_Wechsel.pdf, link from 19.12.2012
[6]Heyman, 2004, Economic and psychologic costs for maternal caregivers of gastrostomy-dependent children. http://www.ncbi.nlm.nih.gov/pubmed/15480377
Samuel Scheer